By Gurpreet Singh, MD and Neeraj Jolly, MD
July is always an interesting month, not the least because new fellows start their training. It is a good time to observe the learning curve of the fresh recruits to the world of cardiology, and begin observing what is difficult to learn. This thought appealed to us two years ago and we decided to compare the procedural variables in radial and femoral diagnostic cardiac catheterization cases, primarily from a fellow’s learning perspective. This was a relevant topic because there is a lot of new literature regarding utility of radial caths, primarily based on data derived from advanced operators’ experience. The relevance of this study was even more for the training programs because more data can help design better training protocols.
Interesting facts came to fore when we analyzed the data. We found that procedure times were longer in radial cases. With training, we observed an improvement in time to gain vascular access. This, therefore, can be a low hanging fruit for improving procedure times in radial cases. Vascular access to procedure end time, however, did not improve substantially in the radial group, suggesting difficulty in learning catheter manipulations. Learning catheter manipulations might be difficult because of the variety of catheters used and variable techniques between operators, not to mention the inherent difficulty in catheter manipulations from a radial access. This is in contrast to femoral access procedures, where Judkins catheters are ubiquitous, and instructions to fellows regarding manipulations of these catheters are fairly uniform.
Another important observation we made is a higher radiation exposure with radial caths. Shah et al found this to be true for experienced operators as well.(1) This is clearly an area that needs further work.
In summary, we hope that radial access catheter selection, instructions to fellows regarding gaining access, and instructions regarding catheter manipulations become more standardized over time. This might help to achieve better procedural variables. We also want to stress that retaining femoral cath skills is essential for many reasons – greater use of hemodynamic support devices and structural heart procedures that require large-bore arterial or venous sheaths, to name a few.
1. Shah B, Bangalore S, Feit F, et al. Radiation exposure during coronary angiography via transradial or transfemoral approaches when performed by experienced operators. Am Heart J. 2013;165(3):286-292.
Read entire article in this month’s Journal of Invasive Cardiology: